With regard to these questions about the expansion of the alliance by the masses, the leaders of the pilot office and the centralized mining office came forward to answer them

On September 26, the national health insurance bureau published the "reply to reporters on the pilot project of centralized drug purchase organized by the state to expand the scope of the region" In order to reduce the burden of drug use and improve the mechanism of drug price formation, the recent pilot project of expanding the scope of drug use carried out by the people from all walks of life will be understood and answered: first, what is the progress and effect of the pilot project of centralized drug purchase and use organized by the state? Person in charge of the pilot office: "4 + 7" pilot project has been running for more than 5 months since it was fully implemented on April 1 this year It is generally stable, the progress of implementation is beyond expectations, the public opinion is good, and the burden of patients' medication costs is significantly reduced As of the end of August, the purchase volume of 25 selected drugs in "4 + 7" cities was 1.7 billion, and the implementation of the agreed total purchase progress was better than expected The purchase volume of selected drugs accounts for 78% of that of generic drugs The bidding and procurement work has truly achieved "procurement with quantity" and "integration of bidding and procurement" The patients have really used the drugs after the price reduction, and walked out of the strange circle that the drugs will be abandoned once the price is reduced, and a new way of bidding, procurement, use and payment has come out With the promotion of the pilot project, the reform effect continues to expand, the industry expectation begins to change, and the marketing mode of pharmaceutical enterprises begins to adjust; the price transmission effect continues to show, and the patent cliff begins to appear; the standardization and rationality of hospital drug use have improved; the consistency evaluation work has been accelerated, and the high-quality supply has increased; the consensus of supply side reform of pharmaceutical industry tends to form The results of the pilot mid-term evaluation conducted by the third-party organization show that the burden of patients' drug expenses is reduced, especially for patients with chronic and serious diseases, and more than 90% of the patients agree with the pilot policy; the transaction cost of enterprises is significantly reduced, and the 30 day recovery rate of 25 selected varieties reaches 97% 2、 What is the consideration of rapidly pushing the "4 + 7" pilot to the whole country? Person in charge of the pilot office: "4 + 7" pilot project has been fully implemented for 5 months, the implementation effect is better than expected, and the pilot reform has achieved positive results Based on the pilot evaluation and summary of relevant experience, the pilot project has been fully launched, with the following main considerations: first, the general expectation of the masses The promotion of the "4 + 7" pilot work has formed a "depression" in the price of relevant drugs in the "4 + 7" pilot city People in non pilot areas hope to expand the scope of the pilot and use the high-quality and low-cost related drugs as soon as possible, and express their wishes to governments at all levels and medical insurance departments through various channels Second, "the people call for something, and the party and the government respond to it." The CPC Central Committee and the State Council fully affirmed the effectiveness of the pilot reform, and listed the pilot expansion as the key task of the Central Committee in comprehensively deepening the reform The executive meeting of the State Council has twice made plans for the pilot expansion of the regional scope, requiring "earnestly summarizing the pilot experience, timely and comprehensively pushing forward", "improving the policy of centralized drug procurement, and accelerating the pilot expansion of centralized drug procurement and use." " Third, the conditions are basically mature The mid-term evaluation concluded that the overall idea, objectives, tasks, principles and main measures of the pilot policy have been well verified and implemented, and can be steadily promoted to the whole country on the basis of further improvement At the same time, the state health insurance bureau, together with relevant departments, has held many symposiums with relevant parties to listen to the opinions on the pilot expansion, and the pharmaceutical industry and enterprises have expressed their active support and participation in the pilot expansion 3、 What are the similarities and differences between the policy requirements of pilot expansion and the "4 + 7" pilot? Person in charge of the pilot office: the pilot expansion is not only the promotion of the previous "4 + 7" pilot results, but also the promotion of the pilot system Therefore, the pilot expansion continues the main ideas, basic principles and policy measures of the "4 + 7" pilot, while responding to the social concerns and improving the rules of the election, which can be summarized as "four insistences and two improvements" in general "Four insistences" refers to: first, adhere to the direction of integration of procurement with volume and bidding Second, adhere to high quality standards, and regard consistency evaluation as the basic threshold for generic drug quality to be shortlisted Third, adhere to the coordination of supporting policies to ensure quality, use, supply and payment collection Fourth, adhere to the overall thinking and working mechanism of "national organization, alliance procurement, platform operation" "Two improvements" refers to: first, the purchase adjustment improves the selection rules and guides the enterprises to compete orderly The second is to expand the pilot to the whole country, increase the number of selected enterprises, avoid supply risk and monopoly risk, and ensure the long-term and stable implementation of the pilot 4、 How to look at the results of pilot expansion and centralized procurement? Person in charge of joint procurement: on September 24, according to the arrangement of pilot expansion work, after fair and open operation, pilot expansion produced the result of proposed winning Relevant pharmaceutical enterprises attach great importance to and actively participate in this centralized procurement, and 77 qualified enterprises participate in the application Finally, all 25 pilot generic drugs have been selected by enterprises, and 45 enterprises have been qualified for the proposed selection Compared with the minimum purchase price of the same kind of drugs in the expansion area in 2018, the proposed selection price has an average decrease of 59%, and the number of proposed selection enterprises and the proposed selection price level are in line with expectations as a whole At present, the results of the proposed selection are still in the publicity period After the publicity period, the joint procurement will determine and release the results of the selection, and do a good job in tracking and urging the implementation The pilot office will guide and promote the participation in the expansion of provinces to formulate implementation plans and supporting policies, realize the results of the election and realize the benefits of the masses 5、 What reform dividend does the pilot expansion bring to the masses in relevant regions? Person in charge of the pilot office: the pilot expansion will bring the following two aspects of reform dividends to the masses in relevant regions: first, reduce the burden of related patients' drug costs 25 provinces participated in the pilot expansion Compared with the lowest purchase price of the same variety in 2018 in the pilot expansion area, the average price reduction in the pilot expansion area is 59% The price reduction effect and substitution effect are superimposed, and the mass reduction effect is more obvious Second, improve the quality of drug use among the masses The pilot expansion adheres to volume procurement, and 50% - 70% of the market procurement will be given to the selected drugs through the consistency evaluation of generic drugs, so as to achieve "quality improvement and price reduction", and take various supporting measures to ensure priority use From the experience of "4 + 7" pilot operation, the proportion of drugs purchased by the same generic drugs through consistency evaluation has been greatly increased After the pilot expansion is fully implemented, it is expected to significantly improve the quality of drug use by the masses nationwide 6、 What will the pilot expansion bring to the pharmaceutical industry? Person in charge of the pilot office: during the policy-making process of the pilot expansion, we held many symposiums, listened to the opinions and suggestions of relevant departments, local governments, pharmaceutical industry associations and relevant enterprises, optimized and improved relevant policies and measures in combination with the concerns of all parties, and the pharmaceutical industry and relevant enterprises had clear expectations for the expansion policies In early September, after the release of the pilot expanded procurement document, the masses generally welcomed it, the pharmaceutical industry generally recognized it, and the capital market showed positive performance According to the results of the pilot expansion, enterprises have a high enthusiasm for participation, 77 enterprises participate in the application, 45 enterprises plan to be selected, and the selection rate is more than 50% The number of enterprises to be selected and the price level to be selected are in line with expectations as a whole In general, the pilot expansion will bring the following impacts to the pharmaceutical industry: first, promote the consistency evaluation of generic drugs The pilot expansion adheres to "consistency evaluation" as the qualification standard for generic drugs to participate in centralized volume purchase, allows fair competition between generic drugs passing the consistency evaluation and original research drugs, and for more than three manufacturers passing the consistency evaluation of the same kind of drugs, no more varieties failing the consistency evaluation will be selected, and the market capacity will be released to the drugs passing the consistency evaluation, so as to promote the fair competition between generic drugs passing the consistency evaluation and original research drugs Enterprises should speed up the consistency evaluation and guide the upgrading of product structure Second, improve the ecology of the pharmaceutical industry The pilot expansion will promote the improvement of drug purchase and sale mode nationwide, reduce the transaction costs of corporate public relations, sales and money compression, guide doctors and patients to use drugs rationally, purify the pharmaceutical circulation environment, and improve the health of the pharmaceutical industry Third, promote the large-scale development of the industry After the pilot expansion, 25 drugs with volume procurement will cover all regions of the country, with higher requirements for product quality, capacity supply and cost control of enterprises, and enterprises facing greater competitive pressure, which will be conducive to promoting industry optimization and restructuring, gradually changing the situation of small industry scale and low quality, and promoting industry scale, intensive and modern development 7、 How to ensure the supply and quality of the selected drugs after the pilot expansion to the whole country? Person in charge of the pilot office: in order to ensure that the pilot expansion will reach the goal of promoting reform, achieving actual results and benefiting the people's livelihood after being pushed to the whole country, the pilot expansion will be based on the "4 + 7" pilot, combined with the concerns of all parties, improve relevant policies and measures to ensure supply: first, allow more than one winning bidder for each variety, expand the source of drug supply, and appropriately reduce the proportion of agreed purchase volume for the varieties of less than three selected enterprises To reduce supply risk Secondly, the production enterprises are required to supply goods in sufficient quantity according to the purchase agreement, establish the enterprise emergency reserve, inventory and capacity reporting system, implement the independent selection of distribution enterprises by the production enterprises, standardize the distribution behavior through the agreement, and ensure the supply stability Third, we should strengthen the responsibility of supply guarantee of the enterprises in the middle selection, make it clear that the enterprises in the middle selection are the first person responsible for ensuring quality and supply, and stipulate the responsibility of the enterprises in the middle selection in case of quality and supply problems In the implementation of the results, the relevant departments will take effective measures to ensure the quality of the selected drugs: first, supervise and urge the selected enterprises to implement the main responsibility of drug quality and safety, strictly implement the quality control of raw and auxiliary materials, strictly control the source quality risk, strictly organize production according to the approved prescription process, and accelerate the construction of drug information traceability system; second, strengthen the production, circulation and implementation of the selected drugs Use the whole chain of quality supervision, improve the frequency of sampling inspection, strengthen the monitoring of adverse reactions, and increase the accountability of illegal enterprises 8、 How to ensure that the people have access to the selected drugs? Person in charge of the pilot office: the key to the success of the pilot expansion is to ensure that the selected drugs enter the hospital and get priority use, so that the masses can really enjoy the reform dividend The medical security department, together with the health department, will improve the incentive and restraint mechanism of public hospitals to guarantee the achievement of the results From the perspective of the medical security department, the measures to be taken include: first, bringing the use of drugs into the management of the medical insurance agreement, clarifying the liability for breach of contract and the way to deal with it Second, the introduction of payment standard policies Make clear that medical insurance pays for drugs with the same common name and different trade names according to the same payment standard, and guide the insured to use drugs reasonably Third, strengthen the monitoring and control of the purchase and use of the selected drugs and the non selected drugs, and take measures to solve the abnormal situation in time Fourth, for the hospitals that reduce the expenditure of medical insurance fund due to the standardized use of the selected varieties, the total budget of medical insurance in the current year will not be reduced, and the balance of medical service revenue and expenditure will be used as a whole for the personnel salary expenditure according to the requirements of "two permits", so as to mobilize the enthusiasm of medical personnel Fifth, establish and improve the medical insurance evaluation index system of medical institutions, incorporate the use of selected drugs into the medical insurance evaluation index system, and establish the corresponding reward and punishment system From the perspective of the health department, the measures to be taken include: first, unblock the policy channel for the priority purchase and rational use of selected drugs, and ensure that medical institutions do not affect the supply and use of selected drugs on the grounds of cost control, restrictions on the specification and quantity of drugs used by medical institutions, approval by the pharmaceutical Commission, etc The second is to include the selected drugs